Search

Objective The objective of this longitudinal epidemiological study was to investigate the association of risk factors for cardiovascular illness with sleep duration and shift work. Methods This study used data obtained at medical checkups conducted in 1999 and 2006 for the employees of a local government organization in Japan (covering 21,693 male employees and 2109 female employees). The medical checkup data included (1) body measurements, (2) blood test parameters, and (3) replies to a self-administered questionnaire (inquiring about sleep duration, with or without shift work, etc.). On the basis of these data, we conducted multiple logistic regression analyses to study the association between the risk of new-onset obesity, hypertension, hyperglycemia, hypertriglyceridemia, and hypo-high density lipoprotein (HDL) cholesterolemia and shift work as well as sleep duration. Results Among the male subjects who were engaged in shift work, the relative risk of new-onset obesity for those with a sleep duration of less than 5 h was 1.30 (95% CI, 1.14–1.49) higher than for those with sleep duration of 5–7 h. Furthermore, analysis using both engagement in shift work and sleep duration as dependent variables showed that the relative risks of new-onset obesity for those with a sleep duration of less than 5 h were 1.20 (95% CI, 1.09–1.32) for men and 1.7 (95% CI, 1.11–2.87) for women. Conclusions Short sleep duration is associated with onset of obesity.

In recent years, insomnia and short sleep duration have been reported to worsen glucose tolerance. Because only a few prospective studies have investigated this issue in Japan, various aspects have yet to be elucidated. Therefore, we conducted a 2-year prospective study of Japanese local residents in order to examine the association between the onset of glucose tolerance disorders and insomnia/ short sleep duration. In 2005 and 2007, residents of a rural community in Aomori Prefecture, Japan, were sent a self-administered questionnaire, and peripheral blood samples were collected to measure their fasting plasma glucose levels. A total of 497 residents participated in both of the surveys. The incidence of hyperglycemia was calculated as the number of people who had had neither hyperglycemia nor diabetes mellitus at the baseline survey but had eventually developed hyperglycemia at the time of the follow-up survey. Logistic regression analyses were used to examine the association between the onset of hyperglycemia and insomnia/sleep duration. Depression status, which had not been adjusted for in previous studies, was included as a covariate in the logistic regression analyses. A total of 429 participants had neither hyperglycemia nor diabetes mellitus at the baseline; of these, 12 were found to have hyperglycemia at the follow-up survey. Thus, the calculated incidence of hyperglycemia was 2.8%. Multiple logistic regression analyses revealed that the odds ratio for difficulty in initiating sleep with regard to the onset of hyperglycemia was 5.27 (95% confidence interval, 1.48-18.77; P = 0.01). Difficulty in initiating sleep is a risk factor for hyperglycemia.

Background: The aim of the present study was to determine the prevalence of and factors associated with smokingamong Japanese medical students, to help promote effective antismoking measures in this population.Methods: From the 80 university medical schools in Japan, 20 were randomly selected and invited to participate inour survey. The survey focused on medical students and employed an anonymous self-administered questionnaire.Information on each university’s antismoking measures was obtained using a separate questionnaire administered toteaching staff. The survey was conducted from December 2006 through March 2007. Factors associated withsmoking were identified by using the chi-square test and multiple logistic regression analysis.Results: A total of 1619 valid surveys were returned. The overall prevalence of smoking was 13.7% (18.1% amongmen and 5.1% among women). Factors associated with smoking among medical students were male sex, enrollmentat a private medical university, smoking by siblings, alcohol consumption, coffee consumption, insomnia, and lessthan 6 hours of sleep per night.Conclusions: Antismoking education must be further promoted to Japanese medical students, with considerationgiven to the factors associated with smoking behavior found in the present study.Key words: smoking behavior; Japanese medical students; Japan

In this study, we have elucidated the prevalence of and factors associated with nightmares and sleep paralysis in Japanese adolescents. We conducted a survey of first-year senior high school students by employing self-administered questionnaires about nightmare and sleep paralysis. All the subjects were first-year students (1164) from three private high schools. The responses of the remaining 916 subjects (568 boys and 348 girls) were considered valid. We found that in Japanese adolescents, the current prevalence of nightmares is 27.4%, and that of sleep paralysis is 7.2%. The lifetime prevalence of sleep paralysis is 30.4%. Results of the multiple logistic regression analysis revealed factors associated with nightmare and sleep paralysis. With regard to nightmares, the adjusted odds ratios for “female gender”, “bedtime after 12 am”, “wake up time before 6:30 am”, “difficulty maintaining sleep or early morning awakening”, “daily tea drinking”, “poor mental health”, and “presence of sleep paralysis” were significantly high. With regard to sleep paralysis, the adjusted odds ratios for “30 min or more of sleep latency”, “less than 6 h of sleep duration”, “presence of naps”, and “presence of nightmares” were significantly high. These results reveal that nightmare and sleep paralysis are prevalent problems among adolescents as well as adults. Moreover, these conditions are associated with factors of mental health and insomnia, and that these factors are associated with each other. Such associations should be considered in the prevention and treatment of nightmares and sleep paralysis among adolescents.

Background: Despite similar standards of living and health care systems for older persons, there are marked differences in the relative health of the elderly populations in the United States (US) and Japan. We explore the association of overweight and obesity with these health disparities.Methods: Data on older adults from the US National Health Interview Survey (1994) and the Longitudinal Study of Aging II (1994) were compared to similar data from the 1999-2001 Nihon University Japanese Longitudinal Study of Aging. Regression analyses for the 2 countries were conducted to examine the correlates of being overweight and obese, and the relationships of overweight and obesity with activities of daily living functioning, heart disease, arthritis, and diabetes.Results: The prevalence of overweight and obesity is higher in the US than in Japan, as is the prevalence of heart disease, diabetes, arthritis, and functioning problems. Education level and marital status are predictors of overweight for older Americans but not for older Japanese people. Health behaviors affect weight in all groups. The prevalence of functioning problems and disease are more likely to be associated with being overweight in US men and women than in Japanese women, and are not associated with being overweight in Japanese men.Conclusion: Despite similar standards of living and health care systems for older persons, the conditions associated with poor health differ in the US and Japan. Being overweight or obese appears to be related to more functioning problems and arthritis in the US than in Japan.

Objective This study was conducted to clarify the prevalence of alcohol consumption among pregnant women in Japan and its associated factors. Method 344 institutions participated in the survey which was conducted in February 2006. Each subject was requested to fill out a self-administered anonymous questionnaire. Factors associated with alcohol consumption during pregnancy were examined using the chi-squared test and logistic regression analysis. Results The number of effective responses was 18,965. The prevalence of alcohol consumption before the confirmation of pregnancy and during pregnancy was 44.6% and 4.6% respectively. The following items were recognized as being associated with promoting alcohol consumption during pregnancy: greater number of weeks of pregnancy, more pregnancies, fewer years of schooling, being employed, an alcohol consumption before the confirmation of pregnancy, smoking during pregnancy, ignorance about the effects of alcohol consumption on fetuses, receiving advice regarding alcohol abstention, difficulty maintaining sleep, and daytime sleepiness. Conclusion It is important to have a more comprehensive understanding of the factors associated with the alcohol consumption behavior of pregnant women, as revealed in the present study, in order to develop future policies for preventing alcohol consumption among pregnant women.

Although the “gold standard” for diagnosis of tuberculous meningitis (TBM) is bacterial isolation of Mycobacterium tuberculosis , there are still several complex issues. Recently, we developed an internally controlled novel wide-range quantitative nested real-time PCR (WR-QNRT-PCR) assay for M. tuberculosis DNA in order to rapidly diagnose TBM. For use as an internal control calibrator to measure the copy number of M. tuberculosis DNA, an original new-mutation plasmid (NM-plasmid) was developed. Due to the development of the NM-plasmid, the WR-QNRT-PCR assay demonstrated statistically significant accuracy over a wide detection range (1 to 10 5 copies). In clinical applications, the WR-QNRT-PCR assay revealed sufficiently high sensitivity (95.8%) and specificity (100%) for 24 clinically suspected TBM patients. In conditional logistic regression analysis, a copy number of M. tuberculosis DNA (per 1 ml of cerebrospinal fluid) of >8,000 was an independent risk factor for poor prognosis for TBM (i.e., death) (odds ratio, 16.142; 95% confidence interval, 1.191 to 218.79; P value, 0.0365). In addition, the copy numbers demonstrated by analysis of variance statistically significant alterations ( P < 0.01) during the clinical treatment course for 10 suspected TBM patients. In simple regression analysis, the significant correlation ( R 2 = 0.597; P < 0.0001) was demonstrated between copy number and clinical stage of TBM. We consider the WR-QNRT-PCR assay to be a useful and advanced assay technique for assessing the clinical treatment course of TBM.

This study re-examined the prevalence of restless legs syndrome (RLS) among pregnant women in Japan based on the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG), and to epidemiologically clarify factors associated with RLS, including sleep disorders and pregnancy status. A cross-sectional survey was conducted at 344 clinical obstetric institutions in Japan. A total of 19 441 women with a confirmed pregnancy were instructed to complete a self-administered questionnaire during the time they spent waiting for a consultation. univariate and multiple logistic regression analyses were used. The prevalence of RLS among the women was 2.9%. The prevalence by age group exhibited a U-shaped curve with the value for those in their thirties as the minimum. The prevalence became more than twice higher in the third trimester of pregnancy. There were stronger associations between RLS and the third trimester of pregnancy, multipara, smoking, subjective insufficient sleep, difficulty initiating sleep, early morning awakening and excessive daytime sleepiness (OR: 1.92, 0.76, 1.54, 1.68, 2.44, 1.80, 1.89, respectively). The prevalence of RLS among pregnant women in Japan was not as high as previously reported, similar to that for the general Japanese population. As the prevalence of RLS is lower than that in Western countries, genetic backgrounds may contribute more to the observed differences than pregnancy does. In this study, like others, the prevalence of RLS increased during the third trimester of pregnancy, and strong associations were observed between RLS and difficulty initiating sleep and between RLS and difficulty maintaining sleep.

Background: In order to clarify the alcohol consumption status of pregnant women in Japan and the characteristics of pregnant women who abstained from alcohol after their pregnancy had been confirmed, a nationwide questionnaire-based study of alcohol consumption behavior was performed. We also examined the factors associated with alcohol consumption during pregnancy and abstention after the confirmation of pregnancy. Methods: After random sampling, 260 institutions participated in the survey; these were selected from a list of survey points fixed by the Japan Association of Obstetricians and Gynecologists. The study was conducted on pregnant women with confirmed pregnancies by using self-administered anonymous questionnaires during the period from February 1 through 14, 2002. Results: Alcohol consumption during pregnancy was reported in 11.1% of the study participants, and abstention after the confirmation of pregnancy, in 76.9%. Significant associations were recognized between higher education and both alcohol consumption during pregnancy and abstention after pregnancy confirmation. Furthermore, alcohol consumption was significantly associated with parity, smoking, and shorter sleep duration, whereas abstention was significantly associated with less frequent alcohol consumption and knowledge regarding the risk of alcohol consumption. Conclusion: The results clarified the factors associated with alcohol consumption during pregnancy and abstention after the confirmation of pregnancy in Japan.

Background A major mechanism of hypertension in many postmenopausal women is deficiency of female gonadal steroids. A long postmenopausal period may thus represent one factor that influences the prevalence of hypertension because of long periods of estrogen loss. Methods When we conducted a medical survey in northwestern China, we also asked 150 postmenopausal female subjects to provide age at menopause in a questionnaire. Age at menopause ranged from 37 to 57 years for all subjects. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) in all subjects were obtained from 24-h ambulatory blood-pressure monitoring. Results An inverse correlation was identified between age at menopause and SBP and DBP, and a positive correlation was found between postmenopausal period and either SBP or DBP. Blood pressure, age at menopause, and postmenopausal period were not significantly related to body mass index, plasma renin activity, glomerular filtration rate, or urinary excretion values of sodium and potassium. Conclusions Our results clearly demonstrated that higher blood-pressure levels in postmenopausal women depend on age at menopause and postmenopausal period, but not subjects’ age, suggesting that a longer absence of female gonadal steroids represents a major factor contributing to increased blood pressure in elderly women.

Objective. This study was conducted to estimate the prevalence of smoking among pregnant women living in Japan and to analyze the factors associated with their smoking behavior. Method. Five hundred institutions with maternity services were randomly sampled from a list of the Japan Association of Obstetricians and Gynecologists. Of these institutions, 260 participated in the survey which was conducted in February 2002. Using a self-reported anonymous questionnaire, a survey on smoking behavior, drinking behavior and sleep status was conducted on pregnant women. Chi-square tests and logistic regression analyses were used to examine the factors associated with their smoking behavior. Results. Data were obtained from a total of 16,414 pregnant women. The prevalence of smoking during pregnancy was 9.9% [95% confidence interval (CI) 9.4%, 10.4%]. The quit rate of smoking among pregnant woman was 61.9% [95% CI 60.4%, 63.4%]. The odds ratios for smoking during pregnancy were significantly higher in women with relatively young age, less schooling, multiparous, exposure to passive smoking, short sleep duration and in women who drank. Conclusion. Smoking among pregnant women remains an important public health problem in Japan. It is necessary to promote antismoking measures based on the results of this study.

Although the "gold standard" for diagnosis of tuberculous meningitis (TBM) is bacterial isolation of Mycobacterium tuberculosis (M. Tb), there are still several complex issues. Recently, in the diagnosis of TBM, the detection of M. Tb DNA in cerebrospinal fluid (CSF) samples using PCR has been widely performed as more rapid, sensitive, and specific diagnostic method. Based on Taq Man(R) PCR, the authors developed a novel technique of internally controlled quantitative nested real-time (QNRT) PCR assay that provided a prominent improvement in detection sensitivity and quantification. Total 43 CSF samples from 8 serial patients with suspected TBM were analyzed. The CSF samples were collected before and during standard anti-tuberculosis treatments (ATT). The QNRT-PCR assay revealed positive results for 24 out of 43 serial CSF samples (55.8%) collected during the treatment course of ATT. Moreover, the bacterial cell (BC) numbers of M. Tb analyzed by the QNRT-PCR assay decreased gradually, correlating with the improvements of the patient's clinical conditions. Since the QNRT-PCR assay provides the ability to calculate a numerical value for the initial BC numbers of M. Tb in CSF samples, this method is an extremely useful and advanced technique for use in assessing the clinical course of TBM.

Objective Among the existing epidemiologic studies that have examined the relationship between depression and sleep disturbances, there are few nationwide studies that have been conducted on subjects representing the general population. The present study was therefore conducted to clarify the relationship between depression and sleep disturbances, in particular the relationship between depression and both sleep duration and subjective sleep sufficiency, using a large sample representative of the general population. Method The survey was conducted in June 2000, using self-administered questionnaires, targeting a population that was selected randomly from among 300 communities throughout Japan. Among the respondents, data from 24,686 individuals aged 20 years or older were analyzed. The Center for Epidemiologic Studies Depression Scale was used to assess the presence of depression. Sleep status, including sleep duration, subjective sleep sufficiency, and the presence or absence of insomnia symptoms, was evaluated. Results Those whose sleep duration was less than 6 hours and those whose sleep duration was 8 hours or more tended to be more depressed than those whose sleep duration was between 6 and 8 hours. Thus, sleep duration exhibited a U-shaped association with symptoms of depression. As subjective sleep sufficiency decreased, symptoms of depression increased, indicating a linear inverse-proportional relationship. Conclusion The fact that sleep duration and subjective sleep sufficiency exhibited different relationships with symptoms of depression indicates that these 2 sleep parameters each have their own significance with regard to depression. These findings may be useful in the medical management of mental diseases.

There have been only a few studies on the relationship between sleep disturbances and somatic and psychological complaints in Japanese people. In this study, we analyzed this relationship using the data of the health and welfare survey performed in 2000 by the Ministry of Health, Labour and Welfare, Japan. The purpose of this study was to evaluate the relationship between sleep disturbances and somatic and psychological complaints among the Japanese general population. The survey was performed in members of households in 300 areas extracted randomly from all over the country using a self-reported questionnaire. The questionnaire items included somatic and psychological complaints (headache, dizziness, palpitation/dyspnea, epigastric discomfort, constipation/diarrhea, stiff neck/shoulder, backache, easy fatigability, persistent fatigue, irritability, anxiety, and worrying about health) and sleep disturbances. Data obtained from 28 714 subjects, aged 20 years or more, were analyzed. The prevalences of almost all complaints were significantly higher in the females than in the males. In the subjects who had a larger number of somatic and psychological complaints, the prevalence of symptom concerning sleep disturbances, such as difficulty initiating sleep, difficulty maintaining sleep, early morning awakening, insomnia, short sleep duration, and subjective insufficient sleep, were higher. Multivariate analysis demonstrated that individual somatic and psychological complaints were independently associated with each symptom of sleep disturbance. It is important to apply the results of this study to the treatment of sleep disturbances and sleep hygiene.

BACKGROUND: Benefits of breast-feeding are not only limited to nutrition and sanitation in developing countries but also extend to cost-saving health care and alleviation of anxiety related to childrearing in developed countries. This study aims to elucidate factors associated with exclusive breast-feeding in Japan and use this information to achieve child-rearing support worldwide by promoting breast-feeding.METHODS: This cross-sectional study used data from a survey conducted by Ministry of Health, Labour and Welfare of the Japanese government, the First Longitudinal Survey of Babies in 21st Century. All subjects were infants (n = 53,575) born in Japan in 2001 between January 10 and 17 and between July 10 and 17. According to the data, the exclusive breast-feeding rate in Japan during the first 6 months of life was 21.0%. We examined the factors associated with exclusive breast-feeding using univariate and multivariate logistic regression analyses.RESULTS: Among the factors examined, the adjusted odds ratio (OR) for exclusive breast-feeding was low for late childbearing, low birth weight infants, multiple births, smoking parents, living with grandparents, and feeling burdened by childrearing. The adjusted OR was high for factors that included sufficient childcare leave and consultation about childrearing with the spouse, a birth attendant and/or nurse, and a peer in a child-rearing circle.CONCLUSIONS: Exclusive breast-feeding is associated not only with medical factors but also with social factors. This study clarifies the necessity of social support to reduce the child rearing burden and a political system to promote paternal participation in childrearing and to improve the childcare leave system.J Epidemiol 2006; 16: 57-63.

Background. Pregnant women suffer from sleep disturbance, which may be aggravated by smoking and/or drinking. We investigate here the joint effect of smoking and drinking with respect to sleep disturbance during pregnancy. Methods. Survey of about 16,000 pregnant women in Japan, conducted in 2002 using a self-administered questionnaire. Results. Both smoking and drinking increased the odds of sleep disturbances, such as subjective insufficient sleep, difficulty in initiating or maintaining sleep, early-morning awakening, short sleep duration, excessive daytime sleepiness and restless legs syndrome. The joint odds ratios for smoking and drinking corresponded more or less to the products of the odds ratio for smoking or drinking. Conclusion. Smoking and drinking are independently associated with increased sleep disturbance during pregnancy, in addition to their other well-known side-effects.

This study sought to determine the relationship of job type differences to burnout level, the details of job characteristics for each job type, and the association between burnout and job factors in 189 social workers at all social welfare offices in a prefecture in Japan. Among the three job types, 32.9% of social workers involved with public assistance, 29.0% of social workers involved with public assistance, the elderly, the disabled and single mothers, and 15.2% of social workers involved with the elderly, the disabled and single mothers were scored in the "high burnout" category (p

Aim. This paper reports a study estimating the nationwide prevalence of and attitudes towards smoking among Japanese nursing students. Background. The World Health Organization established ‘World No Tobacco Day’ in 1987, and has been promoting antismoking measures worldwide since then, with annual themes. It has emphasized that health care professionals, including nurses, as role models for healthy living, should not smoke, and that as promoters of health education they should not seem to justify or condone their patients’ smoking. To promote antismoking measures among nurses, it will be necessary to scrutinize the smoking habits and behavior of nursing students and associated factors, and to conduct effective antismoking education and health education before they acquire the smoking habit. Methods. A cross-sectional survey was carried out through self-administered, closed-ended, structured questionnaires. Questionnaires were mailed to 4169 nursing students at 27 randomly selected vocational nursing schools nationwide. Smoking status, history, and attitudes towards smoking were examined. Results. Smoking prevalence among female nursing students was 23·5%, which was higher than that among the Japanese general female population aged 20–29 (21·9%). Smoker-students were significantly more positive toward smoking than non-smokers in all opinions about health care professionals’ smoking. Multiple logistic regression analysis showed that smoking statuses of the people around the participants, dissatisfaction with being a nursing student, and living alone were associated with participants’ smoking behaviour. Conclusions. The results of the present study suggest an urgent necessity to provide effective antismoking measures for nursing students.

BACKGROUND: Excessive daytime sleepiness is one of the principal symptoms of sleep disturbances,and is often associated with serious consequences including traffic and industrial accidents, decreased productivity, and interpersonal problems. However, there are few epidemiologic studies on excessive daytime sleepiness in a large scale sample targeting Japanese general population.METHODS: The survey was performed using a self-administered questionnaire in June 2000, targeting a population randomly selected from among 300 communities throughout Japan. This questionnaire included information about sleep habits and sleep problems. Excessive daytime sleepiness measured according to a question "Do you fall asleep when you must not sleep (for example when you are driving a car)?"RESULTS: A total of 28,714 subjects completed the questionnaire. The prevalence of excessive daytime sleepiness was 2.5% (male=2.8% and female=2.2%). Backward elimination analysis showed that the following were associated with excessive daytime sleepiness: male sex, young age, short sleep duration, subjective insufficient sleep, loss of deep sleep, disagreeable sensations in the legs, interruption of sleep by snoring or dyspnea, and feeling psychological stress. Interruption of sleep by snoring or dyspnea was the strongest associated factor (adjusted odds ratio=2.46, 95% confidence interval=1.76-3.43) of excessive daytime sleepiness.CONCLUSIONS: These results suggest that excessive daytime sleepiness in Japanese is associated with several sleep problems. These findings may be useful in attempts to prevent excessive daytime sleepiness in the general population of Japan.J Epidemiol 2005;15:1-8.

A questionnaire survey was conducted with questions from the 12-item General Health Questionnaire, among others, targeting 4,407 nurses in 8 general hospitals in Japan, in the hope of improving the work environment of nurses and to provide data that will allow a discussion of the measures necessary for preventing medical errors, thus improving occupational health. For each type of accident, the percentage of those who had made medical errors was significantly higher for the "mentally in poor health" group than for the "mentally in good health" group (p

Background: Prognostic indicators for patients with liver cirrhosis accompanied by esophageal varices are hemorrhage of the varices and development of hepatocellular carcinoma (HCC). Although predictors for HCC have been reported, few studies have investigated the correlation between carcinoma development and endoscopic findings of bleeding varices. We examined whether endoscopic variceal findings such as form (F factor), color (C factor) and red color sign (RC factor) predict development of HCC. Methods: This study included 124 patients with liver cirrhosis who received treatment for bleeding esophageal varices. Patients were followed up with blood chemistries including α-fetoprotein and by abdominal ultrasonography and computed tomography. The primary outcome measure of this study was the cumulative incidence of HCC after the treatment for esophageal varices. The secondary measure was whether endoscopic factors predicted the HCC development, and if so, which factors. Results: During follow-up, 32 of the 124 patients developed HCC. The cumulative carcinogenic rate after 3, 5 and 10 years was 11.8, 25.8 and 37.8%, respectively. Among the 32 patients who developed HCC, 29 (90.6%) had large esophageal varices (large F factor) prior to treatment of the varices. As the F factor increased, the percentage of patients who developed HCC also increased. In particular, independent predictors for HCC were: history of blood transfusion (p = 0.037), presence of hepatitis C virus antibody (p = 0.005), platelet count 4/ml (p = 0.004), α-fetoprotein level >10 ng/ml (p = 0.030), and large F factor (F3) (p = 0.002). Variceal RC and C factors were not independent predictors for carcinogenesis. Conclusion: The endoscopic F factor rating of bleeding esophageal varices can be a significant predictive factor for HCC in patients with liver cirrhosis.

Mental Health and Job Factors in Social Workers at Social Welfare Offices: Fumi TAKEDA, et al. Institute of Health and Sports Sciences, University of Tsukuba—Mental health status and its association with job factors was explored in 55 social workers at seven social welfare offices in a prefecture in Japan. We found that 28 social workers (50.9%) scored in the "high burnout" category and 10 (18.2%) had from moderate to severe depression. There was a significant correlation between the burnout score and the SDS score. The burnout score and SDS score of male social workers were both significantly higher than those of male clerical staff. Male social workers had significantly higher burnout scores than females. Multiple regression analysis showed that burnout was significantly related to a large percentage of time spent on home visits per typical working day and low job satisfaction. Depression was significantly associated with low job satisfaction. These results suggest that social workers with lower job satisfaction may be at higher risk of burnout and depression, and that social workers who devote a large percentage of their work time to home visits may be more likely to suffer from burnout. (J Occup Health 2002; 44: 385-390)

Relationship between Burnout and Occupational Factors in Staff of Facilities for Mentally Retarded Children: Fumi TAKEDA, et al. Department of Health Sciences, Institute of Health & Sports Sciences, University of Tsukuba—Based on the data for 382 nursery teachers and instructors in 71 facilities for mentally retarded children, we studied occupational factors related to burnout in staff of facilities for mentally retarded children. As the result of stepwise multiple regression analysis, burnout scores were significantly related to “work burden”, “work satisfaction”, “dissatisfaction with effectiveness of treatment/instruction”, “emotional support”, and “aversion to dealing with children”. The lower scores in “work satisfaction” and “emotional support” and the higher scores in “work burden”, “aversion to dealing with children”, and “dissatisfaction with effectiveness of treatment/instructions” resulted in the higher burnout scores. These results suggest that it is important to improve the organizational working, support, and training systems. (J Occup Health 2001; 43: 173–179)

Objective: Even when left internal thoracic artery flow is very low, we have used the artery for grafting without any further maneuvers. In this study, we investigated the clinical results of coronary bypass surgery using the left internal thoracic artery with low free flow. Methods: A total of 163 patients were divided into 2 groups: group L (n = 43) had free flow of 20 mL/min or less and group H (n = 120) had free flow of more than 20 mL/min. We performed a comparative study on the basis of coronary angiography and pulsed Doppler echocardiography. Furthermore, 12 months' postoperative graft angiography was carried out in 11 patients from group L. Results: No patient had low output syndrome or perioperative myocardial infarction. One month after the operation, 3 cases of graft occlusion and 9 cases of the "string sign" were identified in group H. However, group L had no graft occlusion and only 1 case of the "string sign." The 1-month postoperative Doppler echocardiographic study showed no significant differences in the diastolic fraction of velocity time integrals and the diastolic/systolic peak velocity ratio of the grafts. In the 11 patients undergoing angiography after 1 year, graft patency was excellent. Moreover, the graft diameter was significantly larger than it was 1 month after the operation. Conclusion: These results suggest that the left internal thoracic artery can be used for coronary artery bypass grafting even when the flow is less than 20 mL/min. (J Thorac Cardiovasc Surg 2000;119:125-9)

We conducted a survey on bone mineral density of adult males living in Japan, for the purpose of clarifying the differences in factors that affect bone mineral density among different age groups and contribute to prevention of osteoporosis. Bone mineral densities of 916 men aged 20 to 69 were measured by dual energy Xray absorptiometry and their lifestyle was examined. The relationship of bone mineral density with BMI (body mass index) and lifestyle factors was examined by applying to the mean value for each item by the unpaired t-test or oneway ANOVA. Multiple regression analysis, in which the bone mineral density was treated as the dependent variable and BMI and lifestyle factors as the independent variables, was applied to evaluate the effects of them. In the age group of 20-29 years old, BMI (p

In order to elucidate the influence of drinking water components and lifestyle on bone density, we carried out chemical analysis of the water drunk by 463 adult females (mean age: 49.9 ± 11.0 years) living in Saitama Prefecture, together with questionnaire survey and ultrasonic bone densitometry measurement. It was found that, in both pre- and post-menopausal women, the larger the body weight the higher the bone density. In the pre-menopausal group, furthermore, bone density tended to increase as the subjects did more frequently out-door activities and as Ca concentration in their drinking water was higher. In the post-menopausal women, higher bone density was associated with higher intake of milk and dairy products at present. According to statistical analysis, the factors whose correlations with bone density were greater in the order: frequency of out-door activities, Ca concentration in drinking water, and body weight for pre-menopausal women; body weight, and the consumption of milk and dairy products for post-menopausal women. Our present results indicated that, in addition to physical factors and lifestyle, Ca concentration in water was related to bone density, though only among women before menopause. In this particular area, therefore, the quality of drinking water might be an important factor which is related to bone density.

We conducted a survey on bone density of adult females living in Chichibu District, Saitama Prefecture, for the purpose of clarifying the differences in factorswhich affect bone density and contribute to prevention of osteoporosis among different age groups. Bone densities of 506 women were measured by ultrasonic bonedensitometry and their lifestyle was examined. By dividing the subjects into 5 age group, the factors associated with bone density differed among them. In the age group of 20 to 39 years old, body weight andexercise habit (at present) were significantly positively associated with bone density. In the age group of 40 to 49 years old, the positive association with body weight and exercise habit (at junior high and senior high schools) was observed. In the age group of 50 to 59 years old, bone density was significantly positively associated with regularity in menstruation and body height, and negatively with smoking habit and delivery history. In the age group of 60 years or more, body weight only was positively associated with bone density. According to the results of this study, the health education for encouraging regular exercise during the period of junior high school through up to about 40 yearsold and smoking cessation was considered to be effective for prevention of the decrease in bone density. However, it seems plausible that exercise is less effective for the individuals aged 60 or more.

DEPRESSION IS SUSPECTED TO BE STRONGLY ASSOCIATED WITH SLEEPING DIFFICULTIES. THE WHO STUDY ON GLOBAL BURDEN OF DISEASES PREDICTED depression would be the second greatest Burden of Disease in 2020 in developed countries.1 These countries therefore urgently need to address the issue of depression. Depression is prevalent among the aged, and it is known that its prevalence rises after the age of 50 among Japanese people.2 It is reported that insomnia can be a precursor or risk factor in depression and that depression could result in insomnia. Thus, the two diseases apparently have a bidirectional relationship.3 Furthermore, insomnia is listed as a major diagnostic feature of depression in the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed (DSM-IV), attesting to the close association of the two diseases.4 This problem has attracted many researchers, and various epidemiological studies have thus far been carried out. In their pioneering longitudinal study, Ford and Kamerow5 reported that those who complained of insomnia at the baseline showed a high risk of developing major depression after one year (odds ratio [OR]: 39.8), while those relieved of insomnia by the time of a second survey showed a much lower risk (OR: 1.6). Breslau et al.6 observed young adults longitudinally for three years and found that those with a history of insomnia at the baseline had a relative risk of 4.0 of developing major depression by a second examination. Chang et al.7 conducted a long-term cohort study in which they followed college graduates up to 45 years. They reported that insomnia in young people could result in the risk of developing depression for at least 30 years. All these studies have confirmed the importance of insomnia as a risk factor of depression and the need for early detection and treatment of insomnia. Riemann and Voderholzer8 reviewed eight longitudinal studies (including the three studies mentioned above) conducted before 2000, which examined the relationship between depression and insomnia. In their review, they listed two other studies dealing with that relationship among those aged ≥ 65 years.9,10 More recently, epidemiological longitudinal studies of the association between insomnia and depression were conducted in various populations: among those ≥ 18 years old in the UK,11 those ≥ 30 years old in Norway,12 young adults in Switzerland,13 the general population in Sweden,14 and those ≥ 65 years old in South Korea.15 All of these studies, again, indicate the effect of insomnia on depression for different populations. These reports, however, did not examine the relationship of depression to the different insomnia subtypes: difficulty initiating sleep (DIS), early morning awakening (EMA), and difficulty maintaining sleep (DMS). Hartz et al.16 examined risk factors for insomnia subtypes by using a cross-sectional survey and concluded that every insomnia subtype is strongly associated with depressive symptoms. Rodin et al.17 stated EMA was more closely related to depression than three other sleep problems, including difficulty falling asleep. Although Rodin et al. collected longitudinal data to examine the relationship between sleep disturbances and depression, their analyses of the relationship were basically cross-sectional in nature. Their analyses suggested that “in the same subject, a decrease in depression is associated with a corresponding decrease in early morning awakening.” Nevertheless, two recent large-scale epidemiological studies in Japan yielded quite different results concerning the relationship between depression and subtypes of insomnia. Using the CES-D to elucidate the relationship of depression to insomnia, Kaneita et al. evaluated 24,686 people (aged ≥ 20 years) throughout Japan for depression.2 Sukegawa et al. studied 2,023 residents aged ≥ 65 years in one city using the Geriatric Depression Scale and Pittsburgh Sleep Quality Index.18 These studies, both of which used questionnaire surveys based on self-rated responses, reported that the closest connection to depression was found not with EMA or DMS, but with DIS. Being cross-sectional studies, however, they could not adequately explore the causal relationship between insomnia subtypes and the presence of depression. We therefore, employed a longitudinal survey on elderly Japanese to examine the temporal association between insomnia subtypes and the presence of depression three years later.

Background: Pregnancy and childbirth can act as strong factors motivating parents to spontaneously quit smoking. The aim of the present survey was to establish smoking cessation guidelines for this group. The objectives were to clarify the smoking status of parents before, during and after pregnancy, as well as the factors associated with continuous smoking during pregnancy and post-partum smoking relapse among women who had stopped smoking during pregnancy. Methods: A cross-sectional survey with self-administered questionnaires was conducted for the parents of the 908 infants who participated in the official medical and dental examination for 18-month-old infants in Itabashi ward, Tokyo, Japan. Results: The prevalence of smoking among women before, during pregnancy, and at post-partum 18 months at 95% confidence intervals was 29.3% (23.3–35.3%), 9.8% (3.0–16.6%), and 23.1 (16.8%–29.4%), and among their spouses it was 64.3% (60.0–68.6%), 58.1% (53.4–62.7%), and 58.2% (53.5–62.8%), respectively. The positive factors associated with smoking among pregnant women were marriage to a smoker, less education, under stress, and part-time employment rather than unemployment. The positive factors associated with smoking relapse after childbirth among women were breast-feeding

Background : A limited number of longitudinal studies have addressed the association between sleep disturbance and mental health status among adolescents. To examine whether each of these is a risk factor for the onset of the other, we conducted a prospective longitudinal study of Japanese adolescents. Methods : In 2004, we performed a baseline study of students attending three private junior high schools in Tokyo, and in 2006, a follow-up study was performed on the same population. The mean age of the subjects was 13 years. The Pittsburgh Sleep Quality Index was used to evaluate sleep disturbance, and the 12-item General Health Questionnaire was used to evaluate mental health status. Results : The subjects were 698 students, of whom 516 were suitable for analysis. The incidence of newly developed poor mental health status during the 2 years leading to the follow-up study was 35.1%. New onset of poor mental health status was significantly associated with new onset of sleep disturbance and lasting sleep disturbance. The incidence of sleep disturbance during the 2 years leading to the follow-up study was 33.3%. New onset of sleep disturbance was significantly associated with new onset of poor mental health status and lasting poor mental health status. Conclusions : Sleep disturbance and poor mental health status increase each other's onset risk.

The association between sleep habits and hemoglobin A1c (HbA1c) level has not been sufficiently examined. In the present study of residents in a local community, the associations between sleep duration and HbA1c level were examined.Self-administered questionnaires were mailed to 1062 residents in a rural community in Japan, and completed questionnaires were collected. At the time of collection, the fasting plasma glucose and Hb(1c levels were measured using peripheral blood samples. For the analyses, values that were considered to represent high levels were a fasting plasma glucose level of 126mg/dl and a HbA1c level of 6.5%. Logistic regression analyses were performed to examine the associations between sleep duration and high fasting plasma glucose or high HbA1c levels.The prevalence of high fasting plasma glucose and high HbA1c levels was significantly high (p0.01) in subjects with a short or a long sleep duration. Logistic regression analyses demonstrated a significant association between high HbA1c level and sleep duration. The adjusted odds ratios for a high HbA1c level showed high values with regard to both short and long sleep durations.HbA1c level showed a U-shaped association with sleep duration. These results suggest that there may be an appropriate range of sleep duration in individuals with glucose tolerance disorders. It is expected that the present findings will contribute to the treatment and prevention of diabetes mellitus.

The purpose of this study was to examine the association between sleep and subjective quality of life in an elderly Japanese population.Elderly people aged 70 years or more (n=1,769) were selected randomly from all areas of Japan. They were visited and interviewed in November 2003. Subjective well-being of the subjects was assessed using the Philadelphia Geriatric Center (PGC) Morale Scale. A logistic regression analysis was performed using sleep-related factors as explanatory variables.A positive linear association was observed between subjective sleep sufficiency and the mean PGC Morale Scale score. The crude and adjusted odds ratios for sleep disorders such as difficulty initiating sleep, excessive daytime sleepiness, and restless legs syndrome were significantly low. The mean score was highest for a sleep duration of 7-8h and became lower at sleep durations of6 and 9h (inverted U-shaped association). However, the adjusted odds ratio for sleep duration did not show a significant reduction.In order to improve the subjective well-being of the elderly, better subjective sleep sufficiency and alleviation of sleep disorders are necessary. Different mechanisms may reduce subjective well-being in individuals who sleep less than 6h or who sleep 9h or more.

Objective: The present study was conducted to clarify the prevalence of the use of alcohol and hypnotic medication as sleep aids, and associated factors, in the general population in Japan. Methods: The survey was conducted in June 2000, using self-administered questionnaires, targeting a population that was selected randomly from among 300 communities throughout Japan. A total of 18,205 responses indicating alcohol use and 16,804 responses indicating hypnotic medication use were analyzed. Results: The prevalence of alcohol use as a sleep aid one or more times per week was 48.3% among men and 18.3% among women. The prevalence of the use of hypnotic medication one or more times per week was 4.3% among men and 5.9% among women. The prevalence of alcohol used as a sleep aid increased gradually for men and women up to age 55–59 years and 40–44 years, respectively, and then declined with increasing age thereafter. The prevalence of the use of hypnotic medication among both men and women showed a trend toward a gradual increase with age. The use of alcohol as a sleep aid was associated with “difficulty maintaining sleep,” but no such problem was associated with the use of hypnotic medication. Conclusions: Alcohol is a more popular sleep aid than hypnotic medication. The factors associated with the use of alcohol and of hypnotic medication are different.

Aim. This paper reports a study to determine the prevalence of excessive daytime sleepiness and sleep habits among hospital nurses and to analyse associations between excessive daytime sleepiness and different types of medical error. Background. It has been reported that sleep disorders, and the tiredness and sleepiness brought about by sleep disorders may be associated with occupational accidents. However, to our knowledge, there has so far been no report on associations between sleep disorders, excessive daytime sleepiness in particular, and occupational accidents among hospital nurses. Methods. The study was a cross-sectional study targeting 4407 nurses working in eight large general hospitals in Japan. An anonymous self-administered questionnaire was used to investigate their sleep patterns and experience of occupational accidents. The data were collected in 2003. Results. The prevalence of excessive daytime sleepiness among hospital nurses in the present study was 26.0%. A statistically significant relationship was observed between having or not having occupational accidents during the past 12 months and excessive daytime sleepiness. Multiple logistic regression analyses on factors leading to occupational accidents during the past 12 months showed statistically significant associations between (1) drug administration errors and (2) shift work and age, between (1) incorrect operation of medical equipment and (2) excessive daytime sleepiness and age, and between needlestick injuries and age. Conclusions. Excessive daytime sleepiness is an important occupational health issue in hospital nurses. It is possible that occupational policies and health promotion measures, such as a provision of sleep hygiene advice and social support at worksites, would be effective in preventing occupational accidents among hospital nurses.

Background. Passive smoking is a well-known health hazard for infants. This study was conducted to: (1) estimate the prevalence of passive smoking among Japanese infants and (2) clarify the prevalence of indoor smoking and associating factors among parents having infants. Methods. Subjects were all 53,575 infants born throughout Japan on January 10–17, 2001 or July 10–17, 2001. When the infants reached 6 months of age, the questionnaires were mailed to the homes. Family members answered questions that included information about the current smoking behavior of the parents. Results. A total of 44,562 questionnaires (83.2%) were analyzed. The prevalence of smoking among the mothers and the fathers were 17.1% and 63.5%. The percentages of mothers and fathers who smoked indoors were 12.1% and 36.2%. The percentage of households where mothers and/or fathers smoked indoors was 37.5%. Multivariate logistic analysis indicated that young age, having a spouse who was a smoker, infants having many siblings, the mother not breast-feeding, and lower annual incomes had significantly higher odds ratios for both the mother's and the father's indoor smoking. Conclusions. Passive smoking is common among Japanese infants. To protect Japanese infants from passive smoking, further public health measures must be taken.

The actual situation regarding the lifestyle of college students in Japan cannot be said to be healthy and future reduction of bone mass is a possible matter for concern. However, there have been only a few reports about the relationship between lifestyle during this period and bone mass, and especially none focusing on males not affected by female hormones. The purpose of this study was thus to investigate the relationship between bone mass and lifestyle in college students of both sexes.Seven hundred and sixty-six college students of both genders were enrolled in this study as subjects and underwent calcaneal quantitative ultrasound with an AOS-100 device (ALOKA). At the same time physical factors, lifestyle and nutrition were also examined with laboratory findings.Physical factors such as stature, weight, body mass index (BMI), percentage body fat and gripping power were more strongly related to calcaneal quantitative ultrasound among females than in male students. Multiple regression analysis using calcaneal Osteo Sono-Assessment Index (OSI) as the dependent variable, and physical factors, lifestyle and nutrition, and laboratory findings as the independent variables, indicated that regular physical activity was strongly related to OSI in both sexes. The OSI in the alcohol-consuming group was significantly higher than that in the non alcohol-consuming group in males, and demonstrated a significant negative correlation with liver function markers, i.e. ALT (GPT) IU/l.It is very necessary to undertake daily physical activity for primary prevention of osteoporosis in both males and females. Bone mass in the alcohol-consuming group was here found to be significantly higher than that in the non alcohol-consuming group, but the study suggested that if the amount of alcohol consumed reaches an extent where liver function markers are affected, bone mass may decrease.

To ascertain-1) the prevalence of depression and psychosocial characteristics in alcoholics who are members of teetotal societies, and 2) the relationship between depression and psychosocial factors.A self-report questionnaire survey was conducted of 184 alcoholic members of seven teetotal societies in a prefecture in Japan. Questionnaires consisted of items on demographics, the self-rating depression scale (SDS), family environment in childhood, self-esteem, coping, and sense of coherence (SOC).1) The mean SDS score was 31.8 points in males and 35.8 points in females. Depression level for the male sample was equivalent to that for male employees. Coping behavior characterized by escape and resignation was more prevalent in the employees. Mean scores of both self-esteem (33.3 points) and SOC (118.7 points) were lower than in general. 2) SDS was significantly related to length of time spent within a teetotal society, self-esteem, SOC, coping behavior characterized by resignation and positive approaches to problem solving. The shorter the time within the teetotal society, the lower the scores for self-esteem, SOC, and coping behavior typified by positive approaches to problem solving; and the higher the score for coping behavior characterized by resignation, the higher the SDS score.The findings of this study suggested that depression in alcoholic members of teetotal societies occurred at similar levels to that for the general population, but that self-esteem, sense of coherence, and suitable coping behaviors were reduced. It was suggested that depression in alcoholics who are members of teetotal societies may be associated with short history of membership in the group, low sense of coherence, low self-esteem, and inappropriate coping behavior.

Study objectives To clarify the prevalence of restless legs syndrome (RLS) in pregnant women living in Japan and to analyze the relationship between sleep problems and RLS, in order to discuss ways for pregnant women to obtain comfortable sleep and to improve the health of both the mother and child. Design A cross-sectional questionnaire survey. Setting 500 clinical institutions with maternity services were randomly sampled from a list of organizations identified in a survey by the Japan Association of Obstetricians and Gynecologists. Of these 500 institutions, 260 participated in the survey. Participants 16,528 pregnant women living in Japan. Interventions N/A. Measurements and results In this survey of pregnant women, the prevalence of RLS was found to be 19.9%. An analysis was conducted on the relationship between RLS and other factors such as subjective evaluation of sleep, difficulty initiating sleep, difficulty maintaining sleep, early morning awaking, and excessive daytime sleepiness. The result of this analysis suggested that women with these sleep-related problems were more likely to have RLS than those without. In addition, RLS was more prevalent in the later stages of pregnancy. Conclusion In the pregnant women in our survey, the prevalence of RLS was found to be 19.9%, which is higher than the prevalence of RLS that has been found in the general public in a previous study. This suggests that RLS-related sleep problems may be an important public health issue among pregnant women in Japan. This finding may have implications for attempts to improve sleep hygiene in this group.

The objective of the study was to identify: 1) what kinds of sleep problems that pregnant women experience in Japan; and 2) the relationships between sleep problems and month of pregnancy, sleep problems and the number of pregnancies, and sleeping hours, by means of a questionnaire given to pregnant women in Japan. Conditions to assure good quality sleep were studied.Of 500 obstetric facilities which were randomly selected from areas surveyed by the Japan Association of Obstetricians and Gynecologists, 260 finally agreed to participate in this study. Women who had their pregnancy confirmed and were on a revisit to the 260 obstetric facilities were enrolled. These pregnant women completed anonymous self-administered questionnaires during the waiting time for treatment and submitted them to the obstetric facilities in sealed envelopes. The questionnaire covered personal attributes such as age and highest level of education, pregnancy status, working status, and patterns of smoking and alcohol drinking. Sleep-related items such as 1) subjective sleep quality, 2) difficulty in getting to sleep, 3) frequent awakenings, 4) waking up too early, 5) sleeping hours and 6) daytime drowsiness were also included.The month of pregnancy was significantly related to four sleep-related items, including difficulty in getting to sleep and waking up too early. With respect to the relationship between the number of pregnancies and sleep problems, significance was found for five sleep-related items, including subjective sleep quality and waking up too early. Poor subjective sleep quality was significantly related to sleeping less than seven hours and whether or not pregnant women had a regular job. It was also suggested that the greater the number of pregnancies, the shorter the sleeping hours. When responses to each sleep-related item were compared between pregnant women and the general population, the former were more likely to have sleep problems.These findings suggest that as well as the number of pregnancies and month of pregnancy with sleeping hours may be factor intimately related to sleep problems during pregnancy. A good quality sleep during pregnancy is vital for normal maternal health and fetal growth and sufficient sleeping hours are therefore needed. Attention should therefore be paid to the finding that pregnant women were more likely to have sleep problems than the general population.

To prevent osteoporosis, which is expected to increase in incidence in this rapidly aging society, in recent years bone mineral density (BMD) has frequently been measured as a predisposition index. However, these measurements are made on different sites with different apparatus, and the results are independently studied by different institutions. In our present investigation, to establish the standard radius BMD as determined by dual-energy X-ray absorptiometry (DXA), we carried out a general population survey in 29 municipalities and prefectures on 11,252 locally residing females aged 15 to 83 years (mean, 35.61 +/- 12.85 years). Their YAM (young adult mean) BMD was estimated at 0.664 +/- 0.054 g/cm2, which was almost the same as the figure given in the 1996 version of the diagnostic criteria for primary osteoporosis. We further studied the relationships of BMD to age and physical factors known to be influential to BMD. It was found that BMD was correlated negatively to age and positively to body mass index (BMI). The average values we obtained for age and physique groups appeared to have provided reliable indices for the primary prevention of osteoporosis.

Corrigendum Corrigendum to ‘‘Association between sleep duration and hemoglobin A1c level” [Sleep Med 9 (2008) 745–752] Hiromi Nakajima , Yoshitaka Kaneita *, Eise Yokoyama , Satoru Harano , Tetsuo Tamaki , Eiji Ibuka , Akiyo Kaneko , Ippei Takahashi , Takashi Umeda , Shigeyuki Nakaji , Takashi Ohida a Division of Public Health, Department of Social Medicine, Nihon University, Tokyo, Japan Department of Social Medicine, School of Medicine, Hirosaki University, Hirosaki, Japan

Summary The standardised mortality ratios (SMR) were obtained for dentists in Tokyo according to the causes of their deaths, in order to compare them with those for general Tokyo citizens. Furthermore, an abridged life table was prepared and those dentists' life expectancies were estimated. The materials used were 560 death certificates for male dentists issued in the 10-year period 1985–1994. The documents were kept at the Health Insurance Co-operative Society for Tokyo Dentists, run by the Tokyo Dental Association (TDA). With the general Tokyo residents as a reference population, the SMRs for dentists were significantly higher for oesophageal and colon cancers and significantly lower for heart diseases and pneumonia/bronchitis. The life expectancy for a 25-year-old dentist in Tokyo was 51.26 years. That at birth was stochastically estimated at 75.37 years, which was some one year shorter than that for an ordinary inhabitant (76.67 years), though the difference was insignificant. Resume Causes de deces et esperance de vie des chirurgiens-dentistes On a obtenu les taux normalises de mortalite pour dles chirurgiens-dentistes de Tokyo, selon les causes de leur deces, afin de les comparer avec ceux des habitants de Tokyo en general. Par ailleurs, on a prepare un tableau abrege de vie et on a estime l'esperance de vie de ces chirurgiens-dentistes. Comme documentation, on a utilise 560 actes de deces pour des chirurgiens-dentistes hommes sur une periode de 10 ans (1985–1994). Les documents etaient conserves a la Societe cooperative d'assurances de sante des chirurgiens-dentistes de Tokyo, geree par l'Association dentaire de Tokyo. En prenant comme reference de population les residents de Tokyo, les taux normalises de mortalite des chirurgiens-dentistes etaient considerablement plus eleves en matiere de cancer du colon et de l'œsophage et etaient bien moins eleves pour les maladies cardiaques et les bronchites/pneumonie. L'esperance de vie pour un chirurgien-dentiste de 25 ans a Tokyo etait de 51,26 ans. Celle-ci etait estimee de maniere aleatoire a la naissance a 57,37 ans, soit environ une annee de moins que celle d'un habitant ordinaire (76,67 ans), bien que la difference soit insignifiante. Zusammenfassung Todesursachen und Lebenserwartung bei Zahnarzten Die standardisierte Sterblichkeitsrate (standardised mortality ratios) nach Todesursache fur Zahnarzte in Tokio wurde mit der fur die allgemeine Tokioter Bevolkerung verglichen. Desweiteren wurde eine gekurzte Lebenserwartungstabelle erstellt und Schatzungen bezuglich der allgemeinen Lebenserwartung der darin aufgefuhrten Zahnarzte vorgenommen. Analysiert wurden 560 Sterbeurkunden mannlicher Zahnarzte, die in den Jahren 1985–1994 verstarben. Die Dokumente stammten von der dem Tokioter Zahnarzteverband unterstehenden Krankenversicherung fur Zahnarzte. Verglichen mit den Angaben fur die ubrige Tokioter Bevolkerung waren die Sterbeziffern bei Zahnarzten infolge Osophagus- und Kolonkarzinom signifikant hoher und infolge Herzerkrankungen und Pneumonie/Bronchitis signikfikant niedriger. Die mittlere Lebenserwartung eines 25jahrigen Zahnarztes in Tokio betrug 51,26 Jahre. Die Lebenserwartung bei Geburt wurde stochastisch auf 75,37 Jahre geschatzt. Dieser Wert lag um ca. ein Jahr unter dem fur die ubrigen Bewohner (75,67) angenommenen, wobei es sich um einen nicht signifikanten Unterschied handelte. Resumen Causas de fallecimiento y expectativa de vida de los odontologos De dentistas de Tokio y de acuerdo con las causas de sus muertes, se obtuvieron porcentajes de mortalidad normalizada (PMN), con el fin de compararlos con las de ciudadanos comunes de la misma ciudad. Se preparo, ademas, un tabla de vida abreviada y se calcularon las expectativas de vida de estos dentistas. Los materiales utilizados fueron 560 partidas de defuncion de odontologos varones emitidos durante un periodo de diez anos (1985 a 1994). Estos documentos habian sido archivados en la Sociedad Cooperativa de Seguro Sanitario para los dentistas de Tokio, que es administrada por la Asociacion Dental de Tokio. Con los residentes de Tokio como poblacion de referencia, los PMNs correspondientes a los dentistas eran considerablemente mas elevados por canceres del esofago y de colon y considerablemente mas bajos por enfermedades del corazon y neumonia/bronquitis. La expectativa de vida de un dentista de Tokio, de 25 anos de edad, era 51.26 anos, que al nacer se habia estimado estocasticamente en 75.37 anos, un ano menos que la calculada para un habitante comun (76.67 anos), aunque la diferencia era insignificante.

This paper discusses the prevalence of selected medical conditions at death among elderly Caucasians and Japanese in Hawaii and the associations among conditions listed in the death certificates of the two ethnic groups during 1976-78. For the individual conditions, wide variations were found in the ratio between the total number of times a condition was mentioned in the death certificates and the number of times it was identified as the underlying cause of death. Distinctly different patterns of disease clustering emerged for deaths involving cancer and those not involving cancer. Although in most situations causal combinations were similar for the two ethnic groups, deaths involving two conditions, cerebrovascular disease and cancer of digestive organs, presented different patterns.